Patients with HIV often go untreated simply because they don’t realize they are infected. It can take up to 10 years for a patient with HIV to start showing symptoms, so the only way to identify every instance of the disease is to test every patient who comes through the doors. That’s why Grady Health System in Georgia started using clinical decision support in Epic to ensure that every eligible patient who arrives at one of their hospitals or clinics is tested for HIV.
At Grady, Epic helps nurses quickly identify which patients are eligible for testing without requiring them to use lengthy questionnaires. Since implementing these changes, Grady has seen a 23–50% increase in unique patients tested every month across all of their sites, and they have identified 574 new cases of HIV. Today, they screen almost 3,000 patients per month across the health system, identifying more HIV-positive patients as early as possible while the disease is more manageable.
One key to Grady’s success has been the so-called “opt-out offer,” which is recommended by the CDC. Nurses at Grady simply tell patients, “We test everyone for HIV. I’ll order a test for you unless you ask me not to.” This wording results in more patients agreeing to the test and reduces the chance that the patient might feel targeted as having high risk for HIV. “We don’t test based on someone’s so-called ‘risk,’” explained Dr. Bijal Shah, the faculty lead for Grady’s HIV prevention program. “We test everyone, because the truth is, we as physicians are not always good at assessing the risk factors and knowing how and when to ask these types of questions.”
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